Chest pain with diffuse ST segment elevation

A man in his 80s presented with persistent chest pain two weeks after receiving radiotherapy for lung cancer. The pain was exacerbated by inspiration and improved while sitting forward. Physical examination revealed a pericardial friction rub on the left sternal border. He had a history of duodenal ulcer and often experienced nausea daily. He had no history of coronary artery disease or tuberculosis and no recent history of infection. Before radiotherapy, his electrocardiogram (ECG) findings did not show any abnormality (fig 1), C reactive protein was 13.4 mg/L (normal range 0-10), and white blood cell count was 7.05×10⁹/L (normal range 3.5-9.5×10⁹).

The patient’s ECG and blood tests were repeated (fig 2). C reactive protein was now 82.89 mg/L, white blood cell count was 10.27×10⁹/L, brain natriuretic peptide (BNP) was 138.4 pg/mL (normal range 0-100), and high sensitivity troponin I was 8.6 pg/mL (normal range 0-34.2).